CALIENTE SPRINGS PHYSICAL THERAPY
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Please call 707-935-3230 to schedule an appointment.
Please complete the following paperwork for your initial appointment with us. Along with your completed paperwork please bring your insurance cards, doctor's referral, and if applicable your medical imaging and/or operative reports. If you do not have a copy of the reports you may request that your doctor's office fax them to us at 707-935-8481.
Patient Questionnaire
To be completed by all patients.
PATIENT QUESTIONNAIRE 1.pdf
Adobe Acrobat document [212.3 KB]
To be completed by all patients.
PATIENT QUESTIONNAIRE 1.pdf
Adobe Acrobat document [212.3 KB]
Medicare Questionnaire
Patients that have Medicare as their Primary or Secondary insurance will need to complete this form IN ADDITION to the Patient Questionnaire.
MEDICARE QUESTIONNAIRE.pdf
Adobe Acrobat document [84.5 KB]
Patients that have Medicare as their Primary or Secondary insurance will need to complete this form IN ADDITION to the Patient Questionnaire.
MEDICARE QUESTIONNAIRE.pdf
Adobe Acrobat document [84.5 KB]
For your review:
NOTICE OF HEALTH INFORMATION PRACTICES
NOTICE OF HEALTH INFORMATION PRACTICES.p[...]
Adobe Acrobat document [3.4 MB]
Adobe Acrobat document [3.4 MB]
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